Honda Masataka, Iijima Kazumoto, Ishikura Kenji, Kaneko Kazunari
Department of Pediatric Nephrology, Tokyo Metropolitan Children's Medical Center, Japanese Society for Pediatric Nephrology (JSPN), Musashidai 2-8-29, Fuchu, Tokyo, 183-8561, Japan,
Clin Exp Nephrol. 2014 Dec;18(6):939-43. doi: 10.1007/s10157-014-0941-x. Epub 2014 Feb 2.
The importance of the transition from pediatric to adult healthcare has recently been recognized. In patients with steroid-sensitive nephrotic syndrome (SSNS), the shift in steroid dose during the transition period is a big problem. Thus, change in treatment methods during this transition need to be clarified.
Questionnaires were sent to all councilors of the Japanese Society for Pediatric Nephrology who managed SSNS in children. The questionnaires asked about steroid dose, informed consent, and transition programs. Councilors in 50 of 57 (87.7 %) institutes responded within 2 weeks.
About one-third of pediatric nephrologists (PNs) did not transfer patients to adult units, and half of PNs followed patients after they reached adulthood (i.e., age >20 years). The dose of steroids after puberty varied between doctors, but 74 % of PNs provided short-term daily therapy. 72 % of PNs informed the patients of the shift in steroid dose, but 26 % of PNs did not. About two-thirds of PNs did not consult with adult nephrologists before the transition from pediatric to adult care. No institute had a transition program for SSNS and 2 institutes had transition coordinators.
Transition programs are needed in Japan. But the difference in the steroid regimen between pediatric and adult patients with SSNS is a barrier to transition. This difference needs to be discussed.
从儿科医疗向成人医疗过渡的重要性最近已得到认可。在激素敏感型肾病综合征（SSNS）患者中，过渡期激素剂量的变化是个大问题。因此，需要明确这一过渡期间治疗方法的变化。
向日本儿科肾脏病学会所有负责管理儿童SSNS的委员发送了调查问卷。问卷询问了激素剂量、知情同意和过渡计划。57个机构中的50个（87.7%）的委员在2周内做出了回应。
约三分之一的儿科肾脏病医生（PNs）没有将患者转至成人科室，一半的PNs在患者成年后（即年龄>20岁）继续跟进。青春期后激素剂量在医生之间各不相同，但74%的PNs采用短期每日治疗。72%的PNs告知了患者激素剂量的变化，但26%的PNs没有。约三分之二的PNs在从儿科护理向成人护理过渡前未与成人肾脏病医生协商。没有机构有针对SSNS的过渡计划，2个机构有过渡协调员。
日本需要过渡计划。但SSNS儿科和成人患者激素治疗方案的差异是过渡的障碍。需要讨论这种差异。
